S292: NIRMATRELVIR/RITONAVIR IN COVID-19 PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES: A REPORT FROMTHE EPICOVIDEHA REGISTRY
Authors: Jon Salmanton-García, Francesco Marchesi, Maria Gomes Da Silva, Francesca Farina, Julio Dávila-Valls, Yavuz M. Bilgin, Andreas Glenthøj, Iker Falces-Romero, Jaap Van Doesum, Jorge Labrador, Caterina Buquicchio, Shaimaa EL-Ashwah, Verena Petzer, Jens VAN Praet, Martin Schönlein, Michelina Dargenio, Gustavo-Adolfo Méndez, Stef Meers, Federico Itri, Antonio Giordano, Laszlo Imre Pinczes, Ildefonso Espigado, Zlate Stojanoski, Alberto Lopez-Garcia, Lucia Prezioso, Ozren Jaksic, Antonio Vena, Nicola Stefano Fracchiolla, Tomas Jose Gonzalez-Lopez, Natasa Čolović, Mario Delia, Barbora Weinbergerová, Monia Marchetti, Joyce Marques DE Almeida, Olimpia Finizio, Caroline Besson, Monika M. Biernat, Toni Valkovic, Tobias Lahmer, Annarosa Cuccaro, Irati Ormazabal Velez, Josip Batinic, Noemí Fernández, Nick de Jonge, Carlo Tascini, Amalia N. Anastasopoulou, Rémy Duléry, Maria Ilaria DEL Principe, Gaëtan Plantefeve, Mario Virgilio Papa, Marcio Nucci, Moraima Carmen Jimenez Balarezo, Avinash Aujayeb, Jose Angel Hernandez Rivas, Maria Merelli, Chiara Cattaneo, Ola Blennow, Anna Nordlander, Alba Cabirta, Gina Varricchio, Maria Vittoria Sacchi, Raul Cordoba, Elena Arellano, Stefanie Gräfe, Dominik Wolf, Ziad Emarah, Emanuele Ammatuna, Ditte Stampe Hersby, Sonia Martín-Pérez, Raquel Nunes Rodrigues, Laman Rahimli, Livio Pagano, Oliver A. Cornely
Journal: HemaSphere (2023)

Background: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Aims: We aime to discover factors associated with mortality in patients receiving nirmatrelvir/ritonavir for the COVID-19 treatment. Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Additionally, a Cox regression was modelled to detect factors associated with mortality. Results: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, versus 74% in patients with no nirmatrelvir/ritonavir (p=0.003). Nirmatrelvir/ritonavir recipients were more likely to have received a 2nd vaccine booster than patients without (13% versus 7%, p=0.04), 5% were admitted to ICU, less than patients not receiving nirmatrelvir/ritonavir (12%, p=0.021). Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448-4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619-8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093-0.732) and obesity (aOR 0.105, 95%CI 0.014-0.776) were not associated with nirmatrelvir/ritonavir use. Overall mortality rate was 11%, and COVID-19 attributable mortality was 9%. In patients treated with nirmatrelvir/ritonavir the mortality rate was 7%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (15%, p=0.023). No other factor was observed explaining the mortality difference. Summary/Conclusion: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was significantly lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Keywords: Hematological malignancy, Immune deficiency, COVID-19, Infection